My ADR journey: Dr. Clavel vs Boeere and the whole story

[Dr_sciatica]

Hello Everyone,

After ending my pro sports career with a terrible spine injury that has left me debilitated for the past 3 year, I have decided to attempt the necessary return to a better life and the game I love so much. Thanks to this site, I realized the only possible way for me to return is with either a fusion or an ADR. I was able to even go further by researching the amazing surgeons recommend by members on this board through their personal experience. I have taken a keen interest in the spinal kinetics M6-L, as I believe it is the way to go for any ADR.

I have thus, decided to share my complete attempt to comeback to living a better life or even the miracle to continue playing the sport I love

I will cover everything from my initial email to the surgical procedure, rehab, and successful return to professional sports.

I have decided to go either between Dr Clavel and Gilete in Barcelona or Dr. Beoree in the UK.

[Dr_sciatica]

Initial Thoughts:

Dr Clavel: I like Dr. Clavel's image and persona. He seems to be an amazing surgeon. I like that he had his specialized training in various countries including Italy and the U.S. He seems like a very multicultural person. I also like the fact the Dr. Clavel is younger in practice. It is obvious that he has huge ambition to build a respectable world-wide reputation. One can clearly see his passion.

Dr. Beoree: Dr. Beoree seems like a down to earth individual. Based on previous research, he is very meticulous in explaining the technical detail in a patients procedure. This to me is a critical factor in knowing if a procedure is right for you or not. He seems quite direct as well, which I like. I also like the fact that his place of operation is in a rural area. I am very drawn to this, as I appreciate quite and fresh air when going under the knife.

[Dr_sciatica]

I went ahead and emailed Dr. Clavel. I set up a 3 page pdf covering my entire medical history with scans
Here is my initial email:


"Hello Dr. Clavel and Gilete, It's a pleasure to email you. I have attached a full lumbar medical case (PDF) explaining all the information regarding my medical history/diagnosis and inquiry. I would like to know if you feel I can be one of your patients.
Please get back to me if you would like me to send any additional information including any medical scans.

Thank You, "


Attachment

Introduction and Brief History
Hello Dr. Clavel and Gilete. It is a pleasure to propose my medical case file to both of you. I am a football player who
was forced to retire from a difficult injury. I have full medical reports in the following pages for your review.
Based on my research, it seems that my issue is between a pars defect/DDD/Spondylolysis at the L5/S1 level.
I am quite interested in the Spinal Kinetics M6-L ADR. My case does not have a clear diagnosis. I am hoping you can
review my file and see if in fact, an M6-L would help alleviate my sciatic symptoms and lumbar issues.



Medical Exams and Diagnosis

EMG(attached): 5/27/2010 Said Medicine and Rehab Center Kuwait
Abnormal spontaneous potentials in the form of positive sharp waves and filbrations- tibialis anterior, extensor hallucis longus, medial gastrocnemius, L5 and S1 paralumbar muscles.
2. Recruitment patterns are still adequate but with increased pholphasic potentials on the a are noted during recruitment above muscles.
3. Normal triphastic potentials with good recruitment on the vasttus medialis and semi- membranosus


MRI Lumbar Spine # 1 (attached): 3/24/2010 Dal Al Shifa Hospital Kuwait
At L4/L5 level" signs of mild broad based bulge, with partial effacement of the anterior epidural fat and slight indentation on the thecal sac and its contents. Free exit nerve root.

MRI Lumbar Spine # 2(Unavailable): 10/07/2010 Miami Sports Clinic . Dr Kalbeck Miami, FL
There is spondylolysis on the right at the L5 level. This was also present on the prior exam (Previous Exam was 04/09/08: No symptoms). Marrow Edema was seen in this location on the prior exam, but is no longer present on this current exam. There is no anterior listhesis at the L5 on S1.
Impression:

1. There is spondlolysis on the right at the L5 Level. This was also present on the prior exam. Marrow Edema was seen in this location on the prior exam, but is no longer present on this current exam.
2. At l4/L5, a mild posterior disc buldge is noted again. There is no spinal stenosis or foraminal narrowing
3. At L5-S1, a posterior disc bulge is again noted. This appears slightly asymmetric to the right. There is no spinal stenosis or foraminal narrowing.

X-Ray( FLX – EXT) L-S: 10/06/2010 Miami Sports Clinic Miami, FL
No clear evaluation

MRN- Pelvis Neurography ( attached) – 3/2/2011- Harley Street Medical Centre London, UK
Technique:
Routine coronal axial sagittal and inclined axial scans using combination of proton density t2 fat suppressed T1 sequences optimized for nerve visualization.
Findings:
The sacrosciatic nueral outflow and lower lumbar flexus was clearly evaluated. The nerves flow out onto the surface for the piriformis muscles in an unobstructed fashion and pass through the greater sciatic notch into the posterior compartment of the thigh exhibiting normal signal with no evidence of any gross anatomical compression or distortion. The piriformis muscle shows normal signal and symmetry. The presacral soft tissues look intact. The common hamstring muscles are normal. The sacroiliac joints are intact. I suspect the presence of L5 pars defects although this is not fully evaluated with this study. The sacra cul-de-sac looks normal. The alcocks canal and the pudendal nerve distribution looks normal.
Conclusion:
I can see no evidence of any type of any specific neurological abnormality in this case. I do note however, the possible presence of L5 pars defect and these may be sometimes implicated in these symptoms. I would therefore advice a CT scan from the L4 through the sacrum to further evaluate the bone structure here.

Other Medical Observations:
Dr. Sinia- Indicated a hole within the disc at L5/S1 during ozone injection procedure.



Patient Symptoms and Treatment History


Symptoms:

Right lower extremity :
1. Tingling and Numbness- bottom sole of the foot, big toe, front ankle
2. Burning sensation in the upper to middle hamstring area.
3. Neural and muscular spasms in the calf muscle and upper middle of hamstring
4. Inferior gluteal nerve mis-fire and nerve pain
5. Lower lumbar back pain- Right side only through L4-S1
6. Pain in L5/S1 disc area noted during decompression and Mckenzie stretches
7. Radiating nerve and leg pain
8- Patient complains of heavy hamstring/ drop foot symptoms.
9- Sacroiliac hip pain- onsets during pronation and walking up stairs (right side only); lliolumbar ligament pain
10- Tightness/immobility pain- medial adductor


Onset of symptoms: 18 months


Previous Treatments:

2. Cortisone/ Lidocaine- L5/S1 par lumbar nerve root
3. Electro-Acupuncture
4. Rehabilitation Routine (Massage: Active Release technique, Graston Technique, etc.)
5. Spinal Decompression
6. Rest

[laid up doc]

Best wishes for your decision-making... I had the opposite feeling about location - would rather have access to bigger hospitals were ANYTHING to go wrong, even non-surgery related problems or accidents w/ myself or my travel partner. also don't need a rental car, easy access to food/shopping. But everyone's different.

What have Boeree and Clavel said they think your diagnosis is? and what have they recommended for treatment?

[Justin]

Dr. Sciatica, thanks for your detailed documentation of your decision-making regarding surgeon / surgery. I am sure this will help other Spine Patients in the future. Keep up the great work!

[KBear]

Welcome to the forum! It sounds like you are off to a great start finding the correct medical procedure and surgeon for you. Best of luck and can't wait to hear more!
Kathy

[Dr_sciatica]

Dr. Clavel has replied to my initial email, Here is what he said:


"Thank you for your summary. It makes things very clear. I would like to see your

scans, specially the latest MRI, CT and xrays. Can you send or upload them for us?

Thank you, Dr. Clavel"

[Dr_sciatica]

I decided to send my Scans to Dr. Clavel along with all other relevant information regarding my injury, so he can take his time with them and have a better look.

Will see what he says and get back post on the journal

[Dr_sciatica]

I also have uploaded My scans Online for all to see.

Here they are:

Part 1: Spine MRI

Invisionfootball's photosets on Flickr


Part 2: MRN Neurography

http://www.flickr.com/photos/69417307@N04/sets/


More to come

[Dr_sciatica]

MRN Part 3

invisionfootballthree's photosets on Flickr